When we get ill: cardiovascular disease

Page last updated: 2019 - due to be refreshed in 2021.

 

1 Five key points      

  1. In Suffolk, it is estimated that 100,000 people were affected by cardiovascular disease in 2017. With the exception of cancer, cardiovascular disease contributes to more years lived with disability and early deaths than any other disease. (2 Why is cardiovascular disease important?)  
     
  2. Although there has been a substantial reduction in deaths from cardiovascular disease in the past 20 years, it remains the second highest cause of death in England.[1] Both locally and nationally, cardiovascular disease will account for around 1 in 4 of all premature deaths before the age of 75. (2 Why is cardiovascular disease important?
     
  3. Aside from being one of the main causes of mortality and morbidity in the UK, cardiovascular disease is also closely associated with health inequalities. Risk factors associated with cardiovascular disease such as smoking, physical inactivity, poor diet and obesity are more common in more deprived areas. (2 Why is cardiovascular disease important?
     
  4. Having high blood pressure or atrial fibrillation are both key risk factors for suffering a heart attack or stroke. So while high blood pressure and atrial fibrillation are not usually a direct reason for being admitted to hospital or dying, they may lead to an increased likelihood of serious complications. (3 What is the local picture
     
  5. Although standards are in place that describe good control of hypertension, it is estimated that only four in ten adults in Suffolk with high blood pressure are both aware of their condition and are managing it properly. (3.1 High blood pressure)

2 Why is cardiovascular disease important in Suffolk?

Cardiovascular disease (CVD) is a general term for conditions which affect the heart or blood vessels caused by atherosclerosis (furring or hardening of artery walls). Atherosclerosis particularly results in coronary heart disease, stroke and peripheral arterial disease but CVD also covers other conditions such as vascular dementia and heart rhythm problems such as atrial fibrillation.

Cardiovascular disease affects around seven million people in the UK and is a significant cause of disability and death.[2] Although there has been a substantial reduction in deaths from cardiovascular disease in the past 20 years, it remains the second highest cause of death in England.[1] Both locally and nationally, cardiovascular disease will account for around 1 in 4 of all premature deaths before the age of 75.[3] In 2017, CVD accounted for more than 15% of total disability adjusted life years (DALYs) in both Suffolk and England, making it the second largest disease burden in the country behind cancer.[4] There are many ways in which CVD can have a serious impact on quality of life. Stroke survivors may lose their speech and have impaired mobility while those with peripheral arterial disease may lose a limb. The breathlessness and exhaustion of severe heart failure can preclude even minimal daily activities and all of these can prevent people returning to employment.

Aside from being one of the main causes of mortality and morbidity in the UK, CVD is also closely associated with health inequalities. Risk factors associated with CVD such as smoking, physical inactivity, poor diet and obesity are more common in more deprived areas so the burden of CVD is experienced disproportionately more by the most deprived communities.[5] Nationally, people living in the most deprived districts experience premature mortality rates from CVD more than twice as high as people living in the least deprived districts.[6]

This section focuses primarily on the following CVD conditions: hypertension, coronary heart disease, atrial fibrillation and stroke. Diabetes is considered in its own section.

3 What is the local picture?       

Note that Suffolk is covered by three Clinical Commissioning Groups (CCGs) and one of them spans Suffolk and Norfolk (Great Yarmouth and Waveney CCG). Figures are presented at CCG level because the data cannot be disaggregated into Great Yarmouth and Waveney.

Having high blood pressure or atrial fibrillation are both key risk factors for suffering a heart attack or stroke. So while high blood pressure and atrial fibrillation are not usually a direct reason for being admitted to hospital or dying, they may lead to an increased likelihood of serious complications.

3.1 High blood pressure

It is estimated that high blood pressure affects more than a quarter of adults in Suffolk.[6] Finding and treating people with high blood pressure is arguably the most effective way to prevent heart attacks, strokes, cognitive decline and premature death and disability. Although standards are in place that describe good control of hypertension, it is estimated that only four in ten adults in Suffolk with high blood pressure are both aware of their condition and are managing it properly.[7]

3.1.1 Prevalence

Within the three CCG areas that cover Suffolk, a total of 138,952 people (of all ages) had a GP registered diagnosis of high blood pressure in 2017/18 (Table 1).[6] Prevalence was higher than East of England in all Suffolk CCGs.[6] Possible reasons may include the comparatively older age profile found in Suffolk or that Suffolk CCGs are more successful at identifying and diagnosing high blood pressure.

Table 1: GP recorded diagnoses of hypertension among individuals of all ages, CCGs, East of England, England, 2017/18 [6]

Table 1: GP recorded diagnoses of hypertension among individuals of all ages, CCGs, East of England, England, 2017/18

Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk. 

Figures about diagnoses of high blood pressure are likely to underestimate the true number of people with high blood pressure in Suffolk. This is because a certain number of people will be living with the condition but have not been formally diagnosed. Based on prevalence estimates developed by Public Health England, between 11.8-13.5% of individuals aged 16 and over in Suffolk have undiagnosed hypertension.[6] Applying these estimates to the Suffolk population would suggest that there are between 74,000-84,000 Suffolk residents aged 16 and over with undiagnosed hypertension.

3.1.2 Treatment for high blood pressure

Diagnosed high blood pressure can be controlled by taking appropriate medication. Among people diagnosed with high blood pressure, having blood pressure below 150/90 mmHg is considered to be under control. Among Suffolk CCGs, the proportion of people with diagnosed high blood pressure whose most recent blood pressure reading was below 150/90 mmHg varies between 76.0% in Great Yarmouth and Waveney CCG and 80.8% in Ipswich and East Suffolk CCG, compared to 78.7% in East of England (Table 2).

Table 2: Proportion of people with a diagnosis of high blood pressure whose last blood pressure reading was 150/90 mmHg or below, CCGs, East of England, England, 2017/18[6]

Table 2: Proportion of people with a diagnosis of high blood pressure whose last blood pressure reading was 150/90 mmHg or below, CCGs, East of England, England, 2017/18[
Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk.

Notes: RAG compares to East of England; RAG calculated using 95% confidence interval.

3.2 Atrial fibrillation

3.2.1 Prevalence

Within the three CCGs areas that cover Suffolk, a total of 21,328 people (of all ages) had a GP registered diagnosis of atrial fibrillation (AF) in 2017/18 (Table 3). Prevalence was higher than East of England in all Suffolk CCGs.[6] Possible reasons may include the comparatively older age profile found in Suffolk or that Suffolk CCGs are more successful at identifying and diagnosing AF. These figures are likely to underestimate the true number of people with AF in Suffolk because a certain number of people living with the condition have not been formally diagnosed.

Table 3: GP registered diagnoses of atrial fibrillation among individuals of all ages, CCGs, East of England, England, 2017/18 [6]

Table 3: GP registered diagnoses of atrial fibrillation among individuals of all ages, CCGs, East of England, England, 2017/18

Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk. 

3.2.2 Treatment for atrial fibrillation

Having AF can increase a person’s risk developing a blood clot, which may result in a stroke. Given this risk, people with diagnosed AF who are at high risk of stroke are prescribed blood thinning medication to reduce the risk of developing blood clots (where clinically appropriate).

Among Suffolk CCGs, the proportion of people with a diagnosis of atrial fibrillation and at high risk of stroke, who are prescribed anti-coagulant therapy varies between 77.4% in Great Yarmouth and Waveney CCG and 85.1% in Ipswich and East Suffolk CCG, compared to 84.2% in East of England (Table 4).

Table 4: Proportion of patients with a diagnosis of atrial fibrillation and at high risk of stroke, who are prescribed anti-coagulant therapy, CCGs, East of England, England, 2017/18[6]

Table 4: Proportion of patients with a diagnosis of atrial fibrillation and at high risk of stroke, who are prescribed anti-coagulant therapy, CCGs, East of England, England, 2017/18[
Notes: RAG compares to East of England; RAG calculated using 95% confidence interval.

Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk.

3.3 Coronary heart disease

3.3.1 Prevalence

Within the three CCGs areas that cover Suffolk, a total of 32,429 people (of all ages) had a GP registered diagnosis of coronary heart disease (CHD) in 2017/18 (Table 5). Prevalence was higher than East of England in all Suffolk CCGs.[6] Possible reasons may include the comparatively older age profile found in Suffolk or that Suffolk CCGs are more successful at identifying and diagnosing CHD. These figures are likely to underestimate the true number of people with CHD in Suffolk because a certain number of people living with the condition have not been formally diagnosed. 

Table 5: GP registered prevalence of coronary heart disease among individuals of all ages, CCGs, East of England, England, 2017/18[6]

Table 5: GP registered prevalence of coronary heart disease among individuals of all ages, CCGs, East of England, England, 2017/18[

Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk. 

3.3.2 Hospital admissions

An elective admission is an admission "that has been arranged in advance (not an emergency admission, a maternity admission, or a transfer)". An emergency admission is one that "is unpredictable and at short notice because of clinical need."[13]

In 2017/18, the age-sex standardised elective hospital admission rate for CHD was comparable in Ipswich and East Suffolk CCG, Great Yarmouth and Waveney CCG and West Suffolk CCG to East of England (Table 6). The age-sex standardised emergency hospital admission rate for CHD was significantly lower in West Suffolk CCG compared with East of England, and comparable in Ipswich and East Suffolk CCG and Great Yarmouth and Waveney CCG (Table 6). 

Table 6: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for coronary heart disease, CCGs, East of England, England, 2017/18[8]

Table 6: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for coronary heart disease, CCGs, East of England, England, 2017/18

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Suffolk County Council. Analysis by Public Health Suffolk. (2018).

3.3.3 Mortality

In 2017/18, the age-sex standardised mortality rate from coronary heart disease was significantly lower in West Suffolk CCG compared with East of England, and comparable in Ipswich and East Suffolk CCG and Great Yarmouth and Waveney CCG (Table 7).[8

Table 7: Age-sex standardised mortality rate per 100,000 registered patients/residents from coronary heart disease, CCGs, East of England, England, 2017/18[8]

Table 7: Age-sex standardised mortality rate per 100,000 registered patients/residents from coronary heart disease, CCGs, East of England, England, 2017/18[

Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).

3.4 Stroke

3.4.1 Prevalence

Within the three CCGs areas that cover Suffolk, a total of 18,044 people (of all ages) had a GP registered diagnosis of stroke in 2017/18 (Table 8). Prevalence was higher than East of England in all Suffolk CCGs.[6] Possible reasons may include the comparatively older age profile found in Suffolk or that Suffolk CCGs are more successful at identifying and diagnosing stroke.

Table 8: GP registered prevalence of stroke among individuals of all ages, CCGs, East of England, England, 2017/18[6]

Table 8: GP registered prevalence of stroke among individuals of all ages, CCGs, East of England, England, 2017/18[

Source: Public Health England. Public Health Profiles. (2018). Available at: https://fingertips.phe.org.uk. 

3.4.2 Hospital admissions

To note, the definition of stroke used here includes acute strokes and other types of ill-defined stroke. This definition has been used to account for the broad range of clinical codes used to record different types and severity of stroke.[9]

Elective admissions for stroke are rare in comparison to emergency admissions. In 2017/18, both the age-sex standardised elective and emergency hospital admission rates for stroke were comparable in Ipswich and East Suffolk CCG, Great Yarmouth and Waveney CCG and West Suffolk CCG to East of England (Table 9).[8]

Table 9: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for stroke, CCGs, East of England, England, 2017/18[8]


Table 9: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for stroke, CCGs, East of England, England, 2017/18[

Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

3.4.3 Mortality

In 2017/18, the age-sex standardised mortality rates from stroke in Ipswich and East Suffolk CCG, Great Yarmouth and Waveney CCG and West Suffolk CCG were all comparable to East of England (Table 10).[8

Table 10: Age-sex standardised mortality rate per 100,000 registered patients/residents from stroke, CCGs, East of England, England, 2017/18[8]


Table 10: Age-sex standardised mortality rate per 100,000 registered patients/residents from stroke, CCGs, East of England, England, 2017/18

Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

3.5 Heart attack

3.5.1 Prevalence

Figures are not published about how many people have survived a heart attack, although it is estimated that 750,000 people alive in England today have survived a heart attack.[1] Based on the assumption that heart attack survivors are equally distributed around England, this estimate would suggest that around 10,000 people living in Suffolk have survived a heart attack.

3.5.2 Hospital admissions

Elective admissions for heart attack are rare in comparison to emergency admissions. In 2017/18, the age-sex standardised elective hospital admission rate for heart attack was comparable in Ipswich and East Suffolk CCG, Great Yarmouth and Waveney CCG and West Suffolk CCG to East of England (Table 11).[8] However, the age-sex standardised emergency hospital admission rate for heart attack was lower in Ipswich and East Suffolk CCG than East of England, comparable in West Suffolk CCG and higher in Great Yarmouth and Waveney CCG.[8]

The higher emergency admission rate in Great Yarmouth and Waveney CCG could be linked to unhealthy behaviours that are generally more common in areas that are relatively more deprived than the rest of the East of England region. Unhealthy behaviours include being overweight, eating an unhealthy diet, smoking and being physically inactive. 

Table 11: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for stroke, CCGs, East of England, England, 2017/18[8]

Table 11: Elective and emergency age-sex standardised hospital admission rates per 100,000 registered patients/residents for stroke, CCGs, East of England, England, 2017/18[

Notes: CCG admission rates calculated per 100,000 registered patients; East of England and England admission rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).

3.5.3 Mortality

In 2017/18, the age-sex standardised mortality rate from heart attack in Ipswich and East Suffolk CCG was significantly lower than East of England, and comparable in Great Yarmouth and Waveney CCG and West Suffolk CCG (Table 12).[8] 

Table 12: Age-sex standardised mortality rate per 100,000 registered patients/residents from heart attack, CCGs, East of England, England, 2017/18 [8]
Table 12: Age-sex standardised mortality rate per 100,000 registered patients/residents from heart attack, CCGs, East of England, England, 2017/18

Source: Suffolk County Council. Analysis by Public Health Suffolk. (2018).Notes: CCG mortality rates calculated per 100,000 registered patients; East of England and England mortality rates calculated per 100,000 residents; RAG calculated using 95% confidence interval.

4 What policies affect cardiovascular disease? 

The NHS Long Term Plan sets out a vision for a sustainable service model which focuses on prevention and health inequalities.[10] The Plan notes that, as a largely preventable disease, CVD can be combated through lifestyle changes and a combination of public health and NHS action on smoking and tobacco addiction, obesity, tackling alcohol misuse and food reformulation. The report also comments on the high numbers of people living with undetected, high-risk conditions such as high blood pressure, raised cholesterol and atrial fibrillation. NHS England plan to replicate the progress made in other countries by identifying and diagnosing these conditions earlier, with major progress achievable through greater joint working between the NHS, the voluntary sector, employers and the public sector.

Public Health England (PHE) have set out some of the key national CVD prevention initiatives that they have delivered in 2018/19.[11] With actions taking place across PHE and involving multiple stakeholders, this publication demonstrates PHE’s continued commitment to CVD prevention. The document is aimed at a broad audience, including those involved in the commissioning and provision of services for cardiovascular disease and its prevention, for example, clinicians, local authorities, service commissioners, public health specialists, the third sector and PHE staff.

The NHS Health Check programme offers free of charge health check-ups for adults aged 40-74. It is designed to spot early signs of stroke, kidney disease, heart disease, type 2 diabetes or dementia. Where early signs of CVD are identified, a healthcare professional can give advice to help reduce the risk of CVD developing.[12]

5 Further information

NICE pathways allow users to navigate the breadth and depth of NICE recommendations on a given subject through topic-based diagrams, linking to the tools and resources that NICE has produced to support the implementation of the guidance. There are several pathways relating to CVD, both in general and specific conditions. pathways.nice.org.uk/pathways/respiratory-conditions

The PHE CVD Fingertips Profile provides an overview of data on cardiovascular and cardiovascular related conditions such as heart disease and stroke. Data presented includes mortality, hospital admissions and disease management and aims to support local commissioners and healthcare professionals when assessing the impact of cardiovascular disease on their local population to make decisions about services in their areas. Additionally, narrative profile reports regarding cardiovascular related conditions are available to download for each clinical commissioning group in England.  fingertips.phe.org.uk/profile/cardiovascular

The Global Burden of Disease (GBD) study provides a tool to quantify health loss from hundreds of diseases, injuries, and risk factors, so that health systems can be improved and disparities can be eliminated. The tools allow decision-makers to compare the effects of different diseases, such as malaria versus cancer, and then use that information at home. To make these results more accessible and useful, a suite of interactive data visualizations are available to analyse the data. Data on various measures of death and disability is now available at local authority level. vizhub.healthdata.org/gbd-compare

As people age, their risk of developing conditions like high blood pressure, heart disease or type 2 diabetes increases. The NHS Health Check programme helps to spot early signs and help prevent these diseases developing. www.healthcheck.nhs.uk

OneLife Suffolk is a healthy lifestyles organisation who can offer free tips and practical advice on a number of health and wellbeing topics.  onelifesuffolk.co.uk

A variety of charities provide information and support about CVD and related risk factors. In addition, British Heart Foundation provides statistics about CVD in the UK. Several British Heart Foundation reports were used when researching this report. www.bhf.org.uk

6 References

[1]         British Heart Foundation, “Heart and Circulatory Diseases Statistics 2015.” [Online]. Available: https://www.bhf.org.uk/what-we-do/our-research/heart-statistics/heart-statistics-publications/cardiovascular-disease-statistics-2015

[2]         British Heart Foundation, “Heart and Circulatory Diseases in the UK.” [Online]. Available: https://www.bhf.org.uk/what-we-do/our-research/heart-statistics

[3]         Public Health England, “Action on cardiovascular disease: getting serious about prevention,” 2016. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/556135/Action_on_cardiovascular_disease-getting_serious_about_prevention.pdf

[4]         Institute of Health Metrics and Evaluation, “Global Burden of Disease 2017 Compare tool,” 2018. [Online]. Available: https://vizhub.healthdata.org/gbd-compare/

[5]         M. Marmot, “Fair Society, Healthy Lives: Strategic Review of Health Inequalities in England post-2010,” 2010. Available: www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf

[6]         Public Health England, “Public Health Profiles,” 2018. [Online]. Available: https://fingertips.phe.org.uk.

[7]         Suffolk County Council, “Suffolk Annual Public Health Report 2015,” 2015. 

[8]         Suffolk County Council and NHS Digital, “Analysis of Hospital Episode Statistics.” 2018.

[9]         R. L. Sacco et al., “An updated definition of stroke for the 21st century: a statement for healthcare professionals from the American Heart Association/American Stroke Association,” Stroke, vol. 44, no. 7, pp. 2064–2089, 2013.

[10]      NHS England, “The NHS Long Term Plan,” 2019. Available at: https://www.longtermplan.nhs.uk/

[11]      Public Health England, “Cardiovascular disease prevention: action plan,” 2018. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/648190/cardiovascular_disease_prevention_action_plan_2017_to_2018.pdf

[12]      NHS, “NHS Health Check.” [Online]. Available: https://www.nhs.uk/conditions/nhs-health-check/

[13]      NHS, “NHS Data model and dictionary for England (version 3),” 2019. [Online]. Available: https://www.datadictionary.nhs.uk.